Gaps in glaucoma care: a systematic review of monoscopic disc photos to screen for glaucoma

Newman-Casey, Paula Anne; Verkade, Angela J.; Oren, Gale A.; Robin, Alan L.

doi:10.1586/17469899.2014.967218

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…Six studies 40–45 have reported low sensitivities (50–67%) for detecting glaucoma with monoscopic disc photography alone. 46 When no ancillary visual field testing was used, even a mydriatic fundus examination by an ophthalmologist had 59% sensitivity and 73% specificity in detecting glaucoma in one study. 29 Kumar and colleagues demonstrated that combining demographic information (age >45 and family history of glaucoma), monoscopic photographs (CDR >0.5), and frequency doubling perimetry testing (abnormal results) increased the sensitivity to detect disease from 67% to 84% compared to disc photos alone.…”

Section: Discussionmentioning

confidence: 95%

Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic Fundus Camera Compared to Portable Nonmydriatic Camera

Miller

Thapa

Robin

et al. 2017

American Journal of Ophthalmology

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Purpose To compare cup to disc ratio (CDR) measurements from images taken with a portable, 45° non-mydriatic fundus camera to images from a traditional table-top mydriatic fundus camera. Design Prospective, cross sectional, comparative instrument validation study. Methods Setting Clinic-based. Study Population 422 eyes of 211 subjects were recruited from the Tilganga Institute of Ophthalmology (Kathmandu, Nepal). Two masked readers measured CDR and noted possible evidence of glaucoma (CDR ≥0.7 or the presence of a notch or disc hemorrhage) from fundus photographs taken with a non-mydriatic portable camera and a mydriatic standard camera. Each image was graded twice. Main Outcome Measures Effect of camera modality on CDR measurement, inter- and intra-observer agreement for each camera for the diagnosis of glaucoma. Results 196 eyes (46.5%) were diagnosed with glaucoma by chart review. 41.2%–59.0% of eyes were remotely diagnosed with glaucoma over grader, repeat measurement, and camera modality. There was no significant difference in CDR measurement between cameras after adjusting for grader and measurement order (estimate=0.004, 95% confidence interval (CI), 0.003–0.011, p=0.24). There was moderate inter-observer reliability for the diagnosis of glaucoma (Pictor (κ=0.54, CI, 0.46–0.61); Topcon (κ=0.63, CI, 0.55–0.70) and moderate intra-observer agreement upon repeat grading (Pictor (κ=0.63 and 0.64, for Graders 1 and 2, respectively); Topcon (κ=0.72 and 0.80, for Graders 1 and 2, respectively). Conclusions A portable, non-mydriatic, fundus camera can facilitate remote evaluation of disc images on par with standard mydriatic fundus photography.

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Section: Discussionmentioning

confidence: 95%

Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic Fundus Camera Compared to Portable Nonmydriatic Camera

Miller

Thapa

Robin

et al. 2017

American Journal of Ophthalmology

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“…Among the same patients at the same time points, graders were more likely to assign a higher c/d if the photograph was taken at a bright intensity setting. This may have significant implications in remote telehealth glaucoma screening given the high specificity of disc photographs compared to clinical examination as a glaucoma screening tool [ 2 , 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of color disc photography as a glaucoma screening tool was first championed by Lichter et al in 1976 [ 1 ], and several subsequent studies comparing color disc photography to clinical examination has shown photographs to have excellent specificity and modest sensitivity in detecting glaucoma [ 2 ]. The 2019 SARS-CoV-2 pandemic (COVID-19) has galvanized renewed interest and efforts for telehealth ophthalmologic care.…”

Section: Introductionmentioning

confidence: 99%

The effect of photographic light brightness on cup to disc ratio grading

et al. 2021

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Background Digital optic disc photographs are integral to remote telehealth ophthalmology, yet no quality control standards exist for the brightness setting of the images. This study evaluated the relationship between brightness setting and cup/disc ratio (c/d) grading among glaucoma specialists. Methods Optic disc photographs obtained during routine examinations under anesthesia were collected to construct an image library. For each optic disc, photographs were obtained at 3 light intensity settings: dark, medium, and bright. From the image library, photograph triads (dark, medium and bright) of 50 eyes (50 patients) were used to construct the study set. Nine glaucoma specialists evaluated the c/d of the study set photographs in randomized order. The relationships between the brightness levels and the c/d grading as well as graders’ years in practice and variability were evaluated. Results The c/d were graded as significantly larger in bright photographs when compared to photographs taken at the medium light intensity (0.53 vs 0.48, P < 0.001) as well as those taken at the dark setting (0.47, P < 0.001). In addition, no relationship was found between ophthalmologists’ years in practice and the variability of their c/d grading (P = 0.76). Conclusion Image brightness affects c/d grading of nonstereoscopic disc photographs. The brighter intensity is associated with larger c/d grading. Photograph brightness may be an important factor to consider when evaluating digital disc photographs.

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“…However, an effective way is still needed to diagnose early POAG on a population level 7 . With the continuous development of computer technology and image segment technology, the research on using machine learning and deep learning to diagnose ocular diseases is growing 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Multimodal Primary Open Angle Glaucoma Early Diagnosing Program Based on Clinical Process

Li³

et al. 2022

Preprint

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Background: Glaucoma is one of the leading causes of blinding disease. Early detection can improve patients’ quality of vision. Effectively identifying primary open angle glaucoma (POAG) using structural and functional examination is critical. Computer aided diagnosis of glaucoma requires multimodal data to find an accurate model for early glaucoma diagnosis. Methods: This study collected 87 early POAG eyes, 85 suspected POAG eyes, and 129 healthy eyes from the ophthalmology department at Second Affiliated Hospital of Harbin Medical University. Retinal nerve fiber layer thickness (RNFLt), intraocular pressure (IOP) value, visual field examination parameters and age were obtained. A powerful deep learning network segmented the FP and extracted optic nerve head (ONH) features. Machine learning classifiers (MLCs) were adopted to get the final classification results and compared with the diagnosis results of glaucoma specialists and general non-glaucoma ophthalmologists. Result: The program diagnosing early POAG, suspected POAG, and healthy eyes made overall Area Under the Curve of 0.97. Dice of optic disc and optic cup segmentation is 0.9631, 0.8435 respectively. Accuracy of the program (0.9004) is higher than general ophthalmologists (0.8195). Specificity of the program (0.9635) is higher than glaucoma specialists (0.9366).Conclusions: The program delivers superior results in diagnosing early POAG. This study’s hybrid deep learning-machine learning framework can assist with clinical decision for early POAG effectively.

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Gaps in glaucoma care: a systematic review of monoscopic disc photos to screen for glaucoma

Cited by 11 publications

References 34 publications

Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic Fundus Camera Compared to Portable Nonmydriatic Camera

Glaucoma Screening in Nepal: Cup-to-Disc Estimate With Standard Mydriatic Fundus Camera Compared to Portable Nonmydriatic Camera

The effect of photographic light brightness on cup to disc ratio grading

Multimodal Primary Open Angle Glaucoma Early Diagnosing Program Based on Clinical Process

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